Problem and relevance: Although palliative care consultation has proven benefits among the critically ill and their families, there are many barriers to optimizing a scalable, efficient delivery system for it that is based on ‘triggers’—clinical criteria highlighting patients in particular need in an intensive care unit setting: Staffing limitations: It is estimated that 35% of all ICU patients meet at least one validated ‘trigger’ criteria for a palliative care consultation. How can hospitals provide this care with limited staffing? Technological challenges: It is currently difficult to identify patients who may benefit the most from a palliative care using the electronic health record (EHR). Social challenges: There are concerns that ICU staff would be hesitant to fully support a trigger system unless they were able to approve the appropriateness of a palliative care consult.
Technology description: To address these barriers, we propose Palliative Care Planner(PCplanner)—an EHR-integrated app system with two key functions that aim to address the problems outlined above. First, PCplanner will enable scalable searches of the EHR informed byvalidated palliative care trigger criteria and display search results in its user interface. Second,the user interface will display patient & family needs as reported by a separate electronic patient reported outcomes (ePRO) tool framed by standard palliative care quality indicators. We will host a short informational video on the companion study website that explains the benefits of palliative care— enhancing buy-in from families who may be suspicious of ‘another doctor.’
Short- and long-term outcomes + potential impact: During this 12-month project, we will develop the PCplanner app and website, optimize its usability through iterative revisions among target users, and then test them in Duke ICUs over 2-3 months. Key outcomes will include clinician & patient satisfaction and acceptability as well as length of stay. Our approach isinnovative because uses novel technology and has a high likelihood of being clinically useful for patients, families, and clinicians alike. Bigger picture impact considerations are that PCplannercould be extended in the future to identify ‘high risk’ clinic patients who could benefit from consults, enable identification of patients who lack documented advance directives, or be used on the hospital ward. Last, PCplanner has direct relevance to specific needs within the entireDuke University Health System, notably the Transforming Our Future focus area of the “ComplexCritically Ill Patient” as well as and national campaigns such as the American Board of InternalMedicine’s Choosing Wisely Campaign in Pulmonary and Critical Care, which lists enhancing access to ICU palliative care as one of 5 key quality indicators that requires urgent attention by health care systems.